The physical and emotional costs of non-compliance

There are multiple costs to non-compliance, including financial, both personal and societal, and physical-emotional. When patients fail to comply with treatment protocols, fail to get prescribed tests, or fail to stop destructive behaviors, there is a societal cost.

Today, I want to address the physical and emotional costs of non-compliance.  I just read a brilliant article by Roxanne Sukol, MD.  Dr. Sukol’s article discussed the fact that diabetes starts 10 years prior to your doctor making a diagnosis and, if addressed early, often can be avoided.  In her article, Dr. Sukol states, “I like my patient vertical.  Not horizontal.”  Most doctors have favorite sayings.  My favorite is, “May you be so blessed as to never know what disease you prevented.”  I’ll add Dr. Sukol’s to my favorite list.

Another one of my favorite sayings is “There is no such thing as pre-diabetes.  Pre-diabetes is like being pre-pregnant.”  Dr. Sukol’s article mentions pre-diabetes, a polite way of telling your patient you are on a 10 year journey to a very bad place.  I diagnose my patients with diabetes way before the textbooks and convention recognizes that they are diabetic.  Yes, on the record, I am politically correct in using that ridiculous term, pre-diabetes.  Off the record, I want my patients to take their condition seriously and do something to positively change their future.

Ages ago, someone told me that life was like a movie playing on a VCR.  His belief was that, at anytime, you could hit the eject button and put a new tape in that would then play to a different ending.  When your doctor identifies a condition, like pre-diabetes, the wise thing to do would be to immediately hit the eject button and insert a new tape.

Why don’t patients comply?  Most just don’t have time to get healthy.  They are too busy making a living and building a future.  Unfortunately, they often build that future on a faulty foundation.

Your doctor does not have a crystal ball.  Dr. Sukol and I cannot tell you what your future holds.  We can predict, with better accuracy than the weatherman, what is coming.  We can tell you how to find shelter, how to survive the storm, or how to avoid it altogether.  Help us help you. Pay attention to what we say.  If you disagree with what we ask of you, tell us.  If you don’t understand what we are saying, ask us to explain it better.  If you can’t afford help, confide in us.  We are your partners in health.  Remember, the life you save may be your own.

Stewart Segal is a family physician who blogs at

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